Liver Function tests

ALT

In general be cautious about elevated liver function tests and always recheck within 4 weeks , within 2 weeks if ALT is above 80.

Clearly if the child is unwell with a viral illness but no other concerns nothing more is required other than documenting return to normal levels within 4 weeks

Refer children whose ALT have not returned normal by 4 weeks.

The reference ranges often give a higher level of ALT as upper limit. Children under 12 levels should be below 30 and above 12 levels should be below 25.

Children having levels 10 X upper limit if otherwise well can have the test repeated in 2 weeks but good to discuss within paediatrics.

If no concerning features and child is well and no other abnormal liver tests other than ALT then usually extensive investigations are not indicated unless there is documentation of persistent elevated ALT at 2 week check

Bilirubin

Isolated bilirubin not over 50 mmol first picked up in teenagers with intermittent jaundice is likely to be Gilbert syndrome. Family history may be present.

Document that is unconjugated, that FBC blood film are normal and liver blood tests are normal and repeat these at 3 months and 12 months.

If all remain normal other than the mild increase bilirubin this is consistent with Gilberts.

Explanation and strong reassurance are necessary to avoid unnecessary tests or anxiety